RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01585
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheel Vehicle Mechanic, medically separated for “anxiety disorder, not otherwise specified (NOS),” with a disability rating of 10%.

CI CONTENTION:  The CI contends that he was not evaluated for his post-traumatic stress disorder (PTSD) condition.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080501	VARD - 20090129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, not otherwise specified (NOS)	9413	10%	A Chronic Acquired Psychiatric Disability variously assessed as Post Traumatic Stress Disorder, Adjustment Disorder, Depressive Disorder, and to include Insomnia	9400-9411	50%	20080423	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Anxiety Disorder, NOS.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s anxiety condition began in March 2007 after a deployment to Iraq.   The CI reported that he witnessed a rocket attack in either July or August of 2006, where at least 15 people were injured and he began to worry about getting hit with a rocket.  The CI admitted he had no documentation of the event.  The CI reported that he had trouble with sleep and dreams of being in a fire after he redeployed; however, he denied flashbacks.
The September 2007 Noncommissioned Officer’s Evaluation Report (NCOER), noted the CI was rated successful and superior in the performance of his duties.  The rater further stated that the CI was “mentally tough, able to manage numerous tasks at one time.”  

Despite treatment, the anxiety disorder condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “anxiety disorder” and “personality disorder” for PEB adjudication.

At the MEB NARSUM examination on 12 October 2007 (5 months prior to separation) the CI noted he felt anxious and had difficulty with expressing emotions.  The CI report that he checked doors, avoided conversations about the military, and jumped when unexpected noises occurred.  He had constant anxiety and irritability and startled easily.  He was sleeping better.  He was prescribed two psychotropic medications to treat depression and anxiety.  He was engaged and worked at a gym supervising other service members and civilians.  Psychological testing showed a tendency to overreact to minor stressors and his thought process was characterized by obsessiveness and indecision.  Mental status examination (MSE) noted an improving depressed mood and mildly anxious affect.  An Axis I diagnosis of anxiety disorder NOS and an Axis II diagnosis of personality disorder NOS were rendered.  Social and industrial impairment was mild.  He was assigned an S3 profile.  

At the 23 April 2008 VA Compensation and Pension (C&P) examination for PTSD, performed 1 month after separation, the CI reported he had been diagnosed with PTSD and was taking three psychotropic medications.  He reported he had nightmares and had hit his fiancée during sleep and was feeling down.  He endorsed flashbacks and anxiety attacks.  He denied legal infractions or friendships.  He made some reference to college courses but indicated he was looking for a job.  The Axis I diagnosis of PTSD and Axis II diagnosis of personality disorder were rendered with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms, impairment.)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety condition 10%, coded 9413 (anxiety), citing mild impairment.  The VA rated the anxiety condition at 50% analogously coded 9400-9411 (generalized anxiety disorder and PTSD) based on the VA C&P examination 1 month after separation, citing occupational and social impairment with reduced reliability and productivity.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health conditions.  The Board first considered if application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case.  Board members agreed that the provisions of VASRD §4.129 were not met, the anxiety condition was not the result of a highly stressful event.

The Board then considered if there was evidence for a §4.130 rating higher than 10%.  The §4.130 criteria for a 10% rating is “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medications.”  Criteria for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, and mild memory loss.”  Both the NARSUM and the VA C&P examinations noted mild social and occupational impairment.  The NCOER, reported 6 months prior to separation, noted the CI had successful and superior performance ratings.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the anxiety disorder condition.

BOARD FINDINGS:  In the matter of the anxiety disorder condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140329, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160010517 (PD201401585)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA